Torbay Council is the sixth smallest unitary council in England with 139,300 residents. While an area of renowned natural beauty, Torbay has residents in extreme need with significant levels of deprivation. For income deprivation affecting children, Torbay is ranked as the 30th most deprived in England and the most deprived in the South West. 

During and since Covid the region has seen a concerning deterioration in children's oral health. Over 10% of three-year-olds and almost a quarter of five-year-olds currently experience tooth decay, which can lead to the child needing extractions under general anaesthetic, a process which presents risk to the child. 

It is not uncommon for children to have extractions of up to six teeth at a time. Hospital admission rates for tooth decay resulting in extraction under general anaesthetic in very young children is over three times the England and South West average. Most extractions are in the 1-9 age group, reflecting the importance of promoting oral health in early and primary years. 

There is a strong relationship between dental decay and social deprivation with children from poorer families suffering higher rates of tooth decay and extraction with the relationship exacerbated by higher levels of poor nutrition, sugar consumption and excess weight in these areas. 

Given that tooth decay is largely preventable, Torbay Council introduced two different schemes promoting better oral health in young children - the Big Brush Club and Open Wide and Step Inside. 

Commissioned by the NHS, delivered in partnership with Torbay Council and provided by At Home Dental, the Big Brush Club is the largest such evidence-based programme in England, being delivered to nearly 50,000 children across the South West. The Big Brush Club promotes 

toothbrushing with fluoride toothpaste during the school day, as well as educating on correct brushing techniques, oral health and healthy eating. Training is also provided to teachers and staff by fully-qualified dental nurses to enable them to run the programme themselves. As part of the first phase, over 2,500 children in primary schools and nurseries across the bay have benefited from the scheme - improving their dental health, combatting decay and building the foundations for a lifetime of good oral health.

The second scheme, known as Open Wide and Step Inside, has seen the Dental Outreach Team go into schools to deliver 45-minute oral health education lessons. The outreach team is run by the Peninsula Dental Social Enterprise, which delivers programmes across Devon and Cornwall. Year 2 children in 24 primary schools across Torbay took part in the programme – representing 77% of the bay's primary schools. The lesson includes a 15-minute animated film followed by an interactive session teaching important messages around oral health. Each child receives a goody bag containing a toothbrush, toothpaste, two-minute timer and a sticker and each class also receives a resource story book for the school library so good habits can continue long after the lesson ended.

Extending these programmes beyond the contractual obligations into Family Hubs, special schools and Pupil Referral Units has broadened their reach. The extended model of delivery is now being taken up across the South West.

Mark Richards, public health specialist, said: ‘Our programme has seen a slowing of the extraction rate in Torbay, and although this is a long-term programme, the direction of travel is a good one, providing a good foundation to make a lasting positive impact on child health and wellbeing.'